Intracranial atherosclerosis-related occlusion (ICAS-O) is frequently encountered at the time of endovascular revascularization treatment (ERT), especially in Asian countries. However, because baseline angiographic findings are similar between ICAS-O and embolism-related occlusion (EMB-O), it is difficult to differentiate the etiologies before the ERT procedure. Moreover, despite successful randomized trials on ERT, results from studies examining the optimal treatment protocol in ICAS-O patients remain unclear. In this review, we describe the clinical and imaging factors that may possibly differentiate ICAS-O from EMB-O. We will also discuss some current hurdles for treating ICAS-O in the hyperacute period and suggest the optimal ERT strategy for ICAS-O patients.
Asian Continental Ancestry Group ; Clinical Protocols ; Diagnosis ; Endovascular Procedures ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism ; Intracranial Thrombosis

In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate. In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae. For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc. The early diagnosis and comprehensive treatment can improve prognosis.
Adult ; Embolism, Fat ; diagnosis ; etiology ; therapy ; Humans ; Intracranial Embolism ; diagnosis ; etiology ; therapy ; Male

PURPOSE: To determine the MR and CT findings which differentiate cerebral septic embolism from thromboticinfarction. MATERIALS AND METHODS: Cerebral septic embolism was confirmed by blood culture in six patients andautopsy in two. The number, size, distribution, contrast enhancement, and hemorrhage of the lesions, as seen on MRand CT, were retrospectively analyzed, and four patients were followed up for between one week and seven months. RESULTS: In a total of eight patients, infective endocarditis (n=5) and sepsis (n=3) caused cerebral septicembolism. The number of lesions was 3~7 in six patients, over 10 in one, and innumerable in one; these varied insize from punctate to 6cm and were distributed in various aseas of the brain. Gyral infarction was noted in fivepatients; non-enhancing patchy lesions involving the basal ganglia or white matter were found in five, tinyisolated nodular or ring-enhancing small lesions involving the cortex and white matter in three, peripheralrim-enhancing large lesions in one, and numerous enhancing nodules disseminated in the cortex in one. Hemorrhagehad occurred in six. Follow-up studies in four patients showed that initial lesions had enlarged in two andregressed in two; new lesions had appeared in two. CONCLUSION: Multiple lesions of different sizes and variouspatterns which include gyral infarction, patchy or nodular lesion in the cortex, white matter or basal ganglia,and isolated small ring-like or nodular enhancement or frequent hemorrhage are findings which could be helpful inthe radiologic diagnosis of cerebral septic embolism.
Basal Ganglia ; Brain ; Diagnosis ; Embolism* ; Endocarditis ; Follow-Up Studies ; Hemorrhage ; Humans ; Infarction ; Intracranial Embolism ; Retrospective Studies ; Sepsis

Percutaneous needle aspiration biopsy is a relatively simple and safe procedure for the diagnosis of lung and mediastinal lesions. Systemic air embolism during and after percutaneous needle aspiration biopsy of the lung is very rare; however, it is still a complication that can cause fatal outcomes, such as cerebral infarction and myocardial infarction. Here, we report a 72-year-old woman who suffered a change in consciousness immediately after receiving a percutaneous needle aspiration biopsy for the pathologic examination of pulmonary nodules found during a routine health medical examination. She had left side weakness and ST segment elevation on an electrocardiogram. After a high concentration of oxygen, she recovered from neurological symptoms and electrocardiographic abnormalities. The authors report a case of air embolism occurring simultaneously in the brain and coronary arteries after percutaneous needle aspiration biopsy.
Aged ; Biopsy ; Biopsy, Needle* ; Brain ; Cerebral Infarction ; Consciousness ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Embolism ; Embolism, Air* ; Fatal Outcome ; Female ; Humans ; Intracranial Embolism ; Lung* ; Myocardial Infarction ; Needles* ; Oxygen

Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation.
Aneurysm, False* ; Diagnosis ; Endocarditis* ; Haemophilus parainfluenzae* ; Heart Valve Prosthesis ; Intracranial Embolism ; Paramyxoviridae Infections

Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation.
Aneurysm, False* ; Diagnosis ; Endocarditis* ; Haemophilus parainfluenzae* ; Heart Valve Prosthesis ; Intracranial Embolism ; Paramyxoviridae Infections

Adolescent ; Humans ; Male ; Pulmonary Embolism ; etiology ; Sinus Thrombosis, Intracranial ; complications ; diagnosis

Child ; Female ; Heart Neoplasms ; complications ; Heart Ventricles ; Humans ; Intracranial Embolism ; diagnosis ; etiology ; Myxoma ; complications

The determination of the embolic source is crucial to understanding the pathogenesis of ischemic stroke, the initiation of appropriate therapy, and the prevention of recurrent infarctions. In this study we undertook to identify the characteristic features on magnetic resonance images of patients who had suffered from stroke due to cardiac embolism (CE), as classified by TOAST (possible and probable). We retrospectively studied magnetic resonance imaging (MRI) findings of patients with ischemic stroke from the Yonsei Stroke Registry (YSR). On the basis of the TOAST classification, 92 patients were identified to have a potential cardiac source of embolism (PCSE), in which 69 patients were found to have high-risk PCSE and 23 patients medium-risk PCSE. To compare their imaging characteristics, another group of 49 patients who were found to have had a stroke due to large artery-to-artery (ATA) embolism-common or internal carotid artery (CCA, ICA)-were identified. Involvement of the simultaneous superficial and deep territories (58.7%; 6.1%, p < 0.001), and combined new anterior and old posterior circulation (15.2%; 2.0%, p = 0.016) were more frequent in PCSE than ATA embolism. Bilateral anterior hemispheric involvement was also more frequent in the PCSE group, but it did not reach statistical significance (13.0%; 4.1%, p = 0.090). ATA embolism tended to involve only superficial territories compared to PCSE (71.4%; 28.3%, p < 0.001). There were no topographic differences between the high-risk and medium-risk groups. With respect to the etiology of PCSE in our population, atrial fibrillation was the most common. Characteristic MRI features of patients with PCSE, which were not documented previously by computed tomography (CT) included: old and new, involvement of multiple different vascular territories, bilateral anterior hemisphere, as well as anterior and posterior circulation. These MRI features, together with simultaneous superficial and deep territorial involvement, help to differentiate the underlying embolic sources, whether they are cardiac or ATA in origin.
Cerebral Infarction/diagnosis* ; Coronary Disease/diagnosis* ; Echocardiography, Transesophageal ; Human ; Intracranial Embolism/diagnosis* ; Magnetic Resonance Imaging ; Registries ; Retrospective Studies

Brain Damage, Chronic ; drug therapy ; Dexamethasone ; therapeutic use ; Embolism, Fat ; diagnosis ; drug therapy ; Female ; Humans ; Intracranial Embolism ; diagnosis ; drug therapy ; Magnetic Resonance Imaging ; Middle Aged